Complication Of Percutaneous Coronary Intervention Research Articles

Effect of Baduanjin exercise on acute myocardial infarction in patients with anxiety and depression after percutaneous coronary intervention: A randomized controlled trial.

Acute myocardial infarction (AMI) is the most severe type of coronary heart disease and patients often require percutaneous coronary intervention (PCI). However, anxiety and depression are common complications of PCI. This study conducted a prospective randomized controlled trial to investigate the effectiveness of Baduanjin exercise in improving cardiac function and alleviating symptoms of anxiety and depression in patients who underwent PCI for AMI. Patients with AMI (n = 120) who underwent PCI at the Cardiology Department of The First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2020 and June 2021 were included. Participants were divided into a control group (moderate intensity walking) and a Baduanjin exercise group. The treatment period was 8 weeks, with follow-ups at weeks 4 and 8. Improvement of cardiac structure and function indices was measured by echocardiography. Physical function was assessed using the 6-minute walk test. Mental state was assessed using the Seattle Angina Questionnaire, Hamilton Anxiety Scale, and Hamilton Depression Scale before and after exercise. Compared to the control group, the Baduanjin exercise group showed improvement in change in left ventricular end-diastolic diameter (-1.0 ± 3.4 vs -2.3 ± 2.7 mm, respectively; P = .02), left ventricular ejection fraction (6.8 ± 4.2 vs 4.5 ± 4.3%, respectively; P = .002), angina stability (42.5 ± 31.7 vs 33.3 ± 29.7, respectively; P = .11), 6-minute walk test (118.4 ± 49.1 vs 88.3 ± 40.2 m, respectively; P < .001), and Hamilton Anxiety Scale (6.7 ± 2.6 vs 5.3 ± 2.6, respectively; P = .003), and Hamilton Depression Scale (7.6 ± 4.1 vs 4.8 ± 2.1, respectively; P < .001) scores. Baduanjin exercise for 8 weeks improved the cardiac function and mental state of patients with anxiety and depression after PCI for AMI. Through this study, we aim to provide reliable evidence in support of the beneficial effects of Baduanjin exercise on cardiac function and anxiety-depression, contributing to evidence-based medicine.

“Kissing-Balloon” Angioplasty Associated Coronary Artery Perforation in Anterior STEMI: A Cautionary Tale

Introduction: Bifurcation technique angioplasty remains one of the most challenging procedures in interventional cardiology, up to 10% of patient with STEMI present with a bifurcation as the culprit lesion. Coronary artery perforation is a known complication of percutaneous coronary intervention and complex coronary anatomy is often posed as a risk factor. Interventional and surgical management of coronary artery perforation is indicated as soon as possible. Case presentation: A 55-year-old male was admitted to the emergency room with severe chest pain 12-hour prior to his admission. An anterior STEMI was diagnosed, and the patient underwent emergency coronary angiography with a bifurcation lesion of the mid LAD and D1, after transient loss of anterograde flow a secondary vessel a “kissing-balloon” technique was performed and type III coronary artery perforation in the Ellis classification of the side-branch was identified. Patient developed cardiogenic shock and urgent thoracotomy was performed. The patient was discharged in good conditions. Conclusion: Coronary artery perforation is a feared complication of percutaneous coronary intervention. Chest pain and hemodynamic deterioration can quickly lead to patient’s death. Identification as soon as possible and interventional or surgical management must be performed.

A simplified bedside model for acute kidney injury prediction after percutaneous coronary intervention

Abstract Background Concern for acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is a major determinant in the decision to pursue cardiac catheterization if otherwise indicated. A bedside AKI risk prediction model derived from the National Cardiovascular Data Registry (NCDR), most recently updated in 2023, employs relatively complex parameters for AKI prediction. Purpose To test the efficacy of a simplified pre-procedural 5-variable bedside score for post-PCI AKI prediction based on the NCDR model. Methods We analyzed our institution’s NCDR-reported catheterization laboratory registry between Q2 2022 and Q1 2023. Inclusion criteria, variable selection, and definitions were based on the NCDR model. A bedside prediction model was validated, including 5 pre-procedural variables: anemia (hemoglobin &amp;lt;10 mg/dl), history of heart failure, stage 4 or 5 chronic kidney disease (glomerular filtration rate &amp;lt;30 mg/dl), cardiac arrest, and shock status. Results We included 840 patients, of which 593 (70.6%) were men. Mean age was 69 (±12.5). Most procedures were performed on an urgent basis (444, 52.9%). AKI developed in 107 (12.7%) patients. Compared to the non-AKI group, patients who developed AKI were older (age 74±11.5 vs 68.3 ±12.5), and more frequently had anemia (23.6% vs 7.4%), diabetes (51.4% vs 35.2%), severe frailty (45.8% vs 23.7%), heart failure (62.6% vs 29.7%), cardiac arrest (13.1% vs 2.9%), CKD (30.8% vs 6%), shock (12.1% vs 1.5%), and mechanical circulatory support (7.5% vs 2.9%), p&amp;lt;0.001. Utilizing integer scores, the simplified bedside model employing 5 pre-procedural variables demonstrated discrimination similar to the bedside NCDR model, with a C-statistic of 0.77 (0.60-0.88) and excellent calibration (intercept of 0.31 and slope of 1.03) (Figure), indicating the robust performance of the model (compared to bedside NCDR model with a C-statistic 0.793, intercept of -0.197, and slope of 0.957). Conclusion A simplified NCDR-based bedside score using 5 pre-procedural variables is an effective tool for predicting AKI as a complication of PCI, with comparable performance to the 2023 updated bedside NCDR AKI risk model.

Catheter-induced ostial coronary artery dissection during percutaneous coronary intervention assessed by intravascular ultrasound

Abstract Background Catheter-induced ostial coronary artery dissection is one of the possible complications of percutaneous coronary intervention (PCI), sometimes resulting in serious consequences. The incidence of catheter-induced ostial coronary artery dissection has been assessed by coronary angiography, but rarely by intravascular ultrasound (IVUS). Prognosis of ostial coronary artery dissection is also unclear. Purpose To determine the incidence and prognosis of catheter-induced ostial coronary artery dissection during PCI by IVUS assessment. Methods The study population consisted of 1468 consecutive patients undergoing PCI at our institution between January 2019 and March 2020. Patients who had previously received a stent in the ostial coronary artery to be treated and patients who were scheduled to receive a stent in the ostial coronary artery during the procedure were excluded. The analysis was performed on 246 patients undergoing IVUS assessment of the ostial coronary artery at the end of the procedure. The 1-year cumulative rates of all-cause death, nonfatal myocardial infarction, and any revascularization procedure were compared between patients with and without ostial coronary artery dissection (dissection and nondissection groups). Results Ostial coronary artery dissection was detected by coronary angiography in 13 patients (5.2%) and by IVUS in 49 patients (19.9%). There were no significant differences between the dissection and nondissection groups (49 patients vs. 197 patients) in the percentage of the treated coronary artery (right coronary artery: 34.7% vs. 36.0%, p = 0.86), acute coronary syndrome (30.6% vs. 41.6%, p = 0.15), or the use of a backup catheter (32.7% vs. 20.8%, p = 0.09). The dissection group had more moderate to severe calcified lesions than the nondissection group (42.9% vs. 22.3%, p&amp;lt;0.01). There were no significant differences between the dissection and nondissection groups in the 1-year cumulative incidence of all-cause death (6.1% vs. 6.6%, p = 0.88), nonfatal infarction (6.1% vs. 4.1%, p = 0.54), or any revascularization procedure (10.2% vs. 8.6%, p = 0.72). Eight patients (16%) in the dissection group received additional intervention for ostial coronary artery dissection and had a significantly higher rate of dissection detected by coronary angiography than conservatively treated patients (75.0% vs. 17.1%, p&amp;lt;0.01). In addition, no conservatively treated patients received additional intervention for worsening dissection within one year of the index procedure. Conclusion IVUS may be more useful than coronary angiography in detecting ostial coronary artery dissection. With proper management, ostial coronary artery dissection may not lead to worse 1-year outcomes, and many dissections detected by IVUS may not require additional intervention.

Respective impact of bleeding and ischemic complications of mortality after percutaneous coronary interventions: substudy from the FRANCE-PCI registry

Abstract Background Patients undergoing percutaneous coronary interventions (PCI) remain at high risk of both bleeding and ischemic events, both burdened with high morbimortality. The respective impact of both type of complications in contemporary PCI, however, remains unclear. Purpose To evaluate and compare the respective impact of ischemic and bleeding complications on mortality after PCI Methods The FRANCE PCI is an ongoing registry of consecutive French patients undergoing PCI and monitored for one year thereafter. Patients presenting with complications after the index PCI were categorized as ischemic complications in case of stent thrombosis, myocardial infarction, stroke or unplanned revascularization, as hemorrhagic complications in case of bleeding BARC ≥3 or as ischemic and hemorrhagic when both types of events occurred in the same patients. The impact of ischemic and hemorrhagic complications on mortality was evaluated separately for the index hospitalization and the 12-months follow-up after hospital discharge, using multivariate logistic model and Cox proportional hazards model, respectively. The multivariate Cox model was developed using complications as time-dependent variables and estimating the hazard ratios (HRs) over 3 periods of time (0 to 8 weeks, 8 to 24 weeks, and 24 to 52 weeks). Consequently, the proportional hazard assumption, tested using the Schoenfeld test, was met for each period. Multiple imputations were performed for missing data on covariates. Results A total of 54,599 patients, with a median age of 69 [60.0-78.0] years, 75.0% male, underwent PCI in 30 centers between 2014 and 2020, in an elective setting for 47% of the cases. During the index hospitalization, an ischemic and hemorrhagic complications occurred in 610 (1.1% 95%CI 1.0-1.2) and 531 (1.0% 95%CI 0.9-1.1) patients, respectively, while the mortality rate was 2.1% 95%CI 2.0-2.2. The association between ischemic, hemorrhagic and ischemic and hemorrhagic events with mortality was aOR 8.4 95%CI 6.4-10.9, aOR 10.3 95%CI 8.1-13.2 and aOR 13.2 95%CI 7.0-24.7, respectively. Among the 51,738 patients alive and not lost-to-follow-up after discharge, an ischemic and hemorrhagic complications occurred in 2,727 (5.3% 95%CI 5.1-5.5) and 1,022 (2.0% 95%CI 1.9-2.1) patients, respectively, while the mortality incidence was 3.8% 95%CI 3.6-4.0. The associations between ischemic, hemorrhagic and ischemic and hemorrhagic events with mortality according to the periods of time are detailed in Table 1 and Figure 1. Conclusion Both ischemic and hemorrhagic complications after PCI are associated with increased risk of mortality. The risk is particularly increased during the early period after the index PCI and diminishes over time, albeit faster after ischemic complications alone, compared to hemorrhagic events alone or the association of ischemic and hemorrhagic complications.

Stent Underexpansion Is an Underestimated Cause of Intrastent Restenosis: Insights From RESTO Registry.

Despite improvement in devices, in-stent restenosis remains a frequent and challenging complication of percutaneous coronary interventions. The RESTO (Morphological Parameters of In-Stent Restenosis Assessed and Identified by OCT [Optical Coherence Tomography]; study NCT04268875) was a prospective multicenter registry including patients presenting with coronary syndromes related to in-stent restenosis. All patients underwent preintervention OCT analysis, which led to analysis of in-stent restenosis phenotype, number of strut layers, and presence of stent underexpansion. The primary end point was the in-stent restenosis type according to the OCT morphological classification. The 1-year incidence of target vessel failure (a composite of death from cardiac causes, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization) was assessed. The study included 297 patients. The culprit stent was a drug-eluting stent in 74.2% of cases. OCT analysis revealed the presence of neoatherosclerosis in 57% (52% calcified), neointimal hyperplasia in 43% (58% homogeneous), stent underexpansion (minimal stent area <4.5 mm2) in 43%, and multiple stent layers in 30%. The prepercutaneous coronary intervention OCT analysis modified the operator's strategy for management in 30% of cases. Treatment involved drug-eluting stent implantation in 61.6% and drug-eluting balloon angioplasty in 36.1% of cases with only 63.2% optimal results. The 1-year target vessel failure incidence was 11% (95% CI, 9%-13%). Residual postpercutaneous coronary intervention stent underexpansion was associated with significantly higher target vessel failure incidence (19% [95% CI, 14%-24%] versus 7% [95% CI, 5-9], P=0.01). OCT identified neoatherosclerosis and neointimal hyperplasia in comparable proportions. Stent underexpansion was frequent and favored subsequent adverse clinical outcomes.

Coronary Endarteritis Secondary to Stent Infection, a Rare but Catastrophic Complication of Percutaneous Coronary Intervention: A Case Series and Review of Literature

Coronary Endarteritis Secondary to Stent Infection, a Rare but Catastrophic Complication of Percutaneous Coronary Intervention: A Case Series and Review of Literature

Different treatment modalities for underexpanded stents-Effectiveness and outcomes: A practical guide.

Underexpanded stents are a dreaded complication of percutaneous coronary intervention (PCI) and are a major predictor of stent thrombosis and in-stent restenosis. Lesion preparation and plaque modification before stent implantation are essential to prevent stent underexpansion and optimize the technical outcomes of PCI. Once stent underexpansion occurs, the treatment options are limited. New devices for the treatment of complex calcified lesions have emerged in the past few years, and experience has accumulated with their use in the treatment of underexpanded stents. This review aims to provide an evidence-based, practical summary of the approach to stent underexpansion, with particular attention to the expected luminal gain, complication rates, and technical nuances of various treatment options. These modalities include the ultrahigh pressure OPN noncompliant balloon, excimer laser coronary angioplasty, rotational and orbital atherectomy, and intravascular lithotripsy. The data gathered for each of these modalities and our experience in treating this complex condition were used to formulate a treatment algorithm for such cases.

Challenges in the diagnosis and management of dry tamponade.

Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.

Unlocking Success: Strategies for Preventing and Managing Complications in Chronic Total Occlusion Percutaneous Coronary Intervention Procedures

Complications in percutaneous coronary intervention (PCI), particularly in chronic total occlusion (CTO) cases, pose notable challenges, with a mortality rate of approximately 0.4% during hospitalization, mainly due to issues like perforation and tamponade. While risk assessment tools can aid in evaluating periprocedural complication risk, prevention and preparedness take precedence. Guided by the "3 Ps" framework—prevention, preparedness, and planning—we navigate the complexities of managing complications in CTO PCI procedures. This emphasizes the importance of comprehensive patient discussions, adherence to appropriateness use criteria, and ensuring a well-trained team equipped with standardized equipment. Furthermore, it is crucial to extract valuable insights from encountered complications, turning potential setbacks into invaluable learning opportunities. This positive approach not only fosters individual growth but also contributes to the advancement of CTO PCI practices. Various complications specific to CTO PCI are addressed, including donor vessel injury, equipment loss/entrapment, radiation injury and coronary perforation.

Timing of percutaneous coronary intervention and risk of new-onset acute ischemic stroke in non-ST elevation myocardial infarction: A retrospective cohort study insight into the National Inpatient Sample Database (2016-2019).

For patients with high-risk non-ST elevation myocardial infarction (NSTEMI), current guidelines recommend an early invasive strategy within 24 h. New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of PCI and the risk of NAIS in NSTEMI is poorly defined. Patients with NSTEMI who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late (>72 h) PCI. Multivariate logistic regression models were used to determine the association between timing of PCI and NAIS. Among 633,115 weighted hospitalizations, patients in the late PCI group had a higher incidence of NAIS (1.3%) than those in the early (0.67%) and medium (0.71%) PCI groups. Patients undergoing late PCI were older, more likely to be female, and had a greater incidence of comorbidities (e.g., diabetes mellitus, chronic pulmonary and renal illness, and atrial fibrillation) than those undergoing early or medium PCI. After adjustment, only late PCI was significantly associated with a 54% increased NAIS risk (adjusted odds ratio: 1.54 [95% confidence interval: 1.29-1.84]). Additionally, there was heterogeneity in the magnitude of risk by age and sex. Younger people (<65 years) (p for interaction <0.001) and men (interaction-value p = 0.040) were more likely to encounter NAIS. Late PCI was associated with a higher risk of NAIS than early PCI, particularly among men and those aged <65 years.

Use of Trapping Techniques and a GooseNeck Snare to Retrieve a Fractured Balloon Catheter.

Percutaneous transluminal coronary angioplasty balloon fracture, retention, and embolization are rare complications of percutaneous coronary intervention. The incidence has historically been estimated at <0.8%, which is likely an underestimate given the increasing quantity and complexity of percutaneous procedures. We demonstrate how to avoid emergency surgery by using basic balloon trapping techniques and a snare in the more distal arterial bed.

Impact of the use of plaque modification techniques on coronary microcirculation using an angiography-derived index of microcirculatory resistance.

Many lesions in patients undergoing percutaneous coronary intervention (PCI) exhibit significant calcification. Several techniques have been developed to improve outcomes in this setting. However, their impact on coronary microcirculation remains unknown. The aim of this study is to evaluate the influence of plaque modification techniques on coronary microcirculation across patients with severely calcified coronary artery disease. In this multicenter retrospective study, consecutive patients undergoing PCI with either Rotablation (RA) or Shockwave-intravascular-lithotripsy (IVL) were included. Primary endpoint was the impairment of coronary microvascular resistances assessed by Δ angiography-derived index of microvascular resistance (ΔIMRangio) which was defined as the difference in IMRangio value post- and pre-PCI. Secondary endpoints included the development of peri procedural PCI complications (flow-limiting coronary dissection, slow-flow/no reflow during PCI, coronary perforation, branch occlusion, failed PCI, stroke and shock developed during PCI) and 12-month follow-up adverse events. 162 patients were included in the analysis. Almost 80% of patients were male and the left descending anterior artery was the most common treated vessel. Both RA and IVL led to an increase in ΔIMRangio (22.3 and 10.3; p = 0.038, respectively). A significantly higher rate of PCI complications was observed in patients with ΔIMRangio above the median of the cohort (21.0% vs. 6.2%; p = 0.006). PCI with RA was independently associated with higher ΔIMRangio values (OR 2.01, 95% CI: 1.01-4.03; p = 0.048). Plaque modification with IVL and RA during PCI increases microvascular resistance. Evaluating the microcirculatory status in this setting might help to predict clinical and procedural outcomes and to optimize clinical results.

Coronary perforation occurring during percutaneous coronary intervention is associated with persistently high mortality and complication.

Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30. The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients suffering from perforation were compared to patients without perforation during PCI. PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12 %) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs 2.5%, OR: 5.6, CI:5-6.3 p<0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period. Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%) with persistently high mortality rates over the years study suggesting that treatment of perforations needs further improvement.

Failure to Rescue After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry.

Failure to rescue (FTR) describes in-hospital mortality following a procedural complication and has been adopted as a quality metric in multiple specialties. However, FTR has not been studied for percutaneous coronary intervention (PCI) complications. This is a retrospective study of patients undergoing PCI from the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry between April 1, 2018, and June 30, 2021. PCI complications evaluated were significant coronary dissection, coronary artery perforation, vascular complication, significant bleeding within 48 hours, new cardiogenic shock, and tamponade. Secular trends for FTR were evaluated with descriptive analysis, and hospital-level variation and clinical predictors were analyzed with logistic regression. Among 2 196 661 patients undergoing PCI at 1483 hospitals, 3.5% had at least 1 PCI complication. In-hospital mortality occurred more frequently following a complication compared with cases without a complication (19.7% versus 1.3%). FTR increased during the study period from 17.1% to 20.1% (P<0.001). The median odds ratio for FTR was 1.48 (95% CI, 1.44-1.53) indicating significant hospital-level variation. Spearman rank correlation demonstrated the modest correlation between FTR and in-hospital mortality, 0.525 (P<0.001). Major procedural complications during PCI are infrequent, but FTR occurs in roughly 1 in 5 patients following a PCI procedural complication with significant hospital-level variation. Improved understanding of practices associated with low FTR could meaningfully improve patient outcomes following a PCI complication.

Incidence, Predisposing Factors, and Outcomes of Periprocedural Myocardial Infarction in Elective Patients Undergoing Coronary Intervention

Objectives: This study aims to investigate the incidence, clinical characteristics, and outcomes associated with periprocedural myocardial infarction (PMI) following elective percutaneous coronary intervention (PCI). Methodology: A retrospective analysis was conducted on 120 patients who underwent elective PCI between January 2023 and December 2023. Data encompassed patient demographics, procedural specifics, and post-procedural outcomes, including PMI occurrence defined by elevated cardiac troponin levels exceeding the 99th percentile upper reference limit. Statistical analyses included logistic regression to evaluate the association of various predictors with PMI incidence. Results: The PMI incidence in our cohort stood at 2.5%. Significant predictors of PMI encompassed older age, male gender, higher lesion complexity, and the utilization of bare-metal stents. Patients experiencing PMI exhibited a substantially higher rate of subsequent major adverse cardiovascular events (MACE) within six months post-procedure (33% vs. 4.27%, p = 0.045). Conclusion: PMI persists as a notable complication of elective PCI, intricately linked to adverse long-term cardiovascular outcomes. These findings underscore the imperative for meticulous patient and procedural selection to mitigate PMI risk. Given PMI's substantial implications for patient prognosis, future research should concentrate on refining risk assessment tools and crafting targeted interventions to reduce PMI incidence and enhance overall patient outcomes.

Anisodamine for the prevention of contrast-induced nephropathy in patients with acute coronary syndrome: a pilot systematic review and meta-analysis of randomized controlled trials.

Contrast-induced nephropathy (CIN) is a common post-procedural complication of percutaneous coronary intervention for acute myocardial infarction (AMI). Anisodamine hydrobromide is an alkaloid that has demonstrated efficacy in improving microcirculation. This meta-analysis aims to evaluate the reno-protective effects of Anisodamine in patients undergoing percutaneous coronary intervention (PCI) for AMI. PubMed, Embase, Cochrane Library, Scopus, and clinicaltrials.gov were searched from inception to January 2024 for randomized controlled trials (RCTs) comparing the efficacy of Anisodamine in preventing the development of CIN. Outcomes of interest included the incidence of CIN, serum creatinine levels, and estimated glomerular filtration rate (eGFR). A random-effects model was used for pooling standard mean differences (SMDs) and odds ratios (ORs) with a 95% CI. Statistical significance was considered at a P less than 0.05. Three RCTs involving 563 patients were included. Anisodamine was associated with a reduction in the incidence of CIN [OR: 0.44; 95% CI: 0.28, 0.69; P=0.0003], a reduction in serum creatinine levels at 48 [SMD: -6.78; 95% CI: -10.54,-3.02; P=0.0004] and 72 h [SMD: -6.74; 95% CI: -13.33,-0.15; P=0.03], and a higher eGFR at 24 [SMD: 5.77; 95% CI: 0.39, 11.14; P=0.03], and 48 h [SMD: 4.70; 95% CI: 2.03,7.38; P=0.0006]. The levels of serum creatinine at 24 h and eGFR value at 72 h were comparable between both groups. Anisodamine has demonstrated clinical efficacy in ameliorating the development of CIN post-PCI in AMI patients. Large, multi-centric RCTs are warranted to evaluate the robustness of these findings.

Outcomes, risk factors, and procedural management of acute myocardial infarction caused by stent thrombosis

Coronary stent thrombosis (ST) is a rare but severe complication of percutaneous coronary interventions (PCIs) with significant implications for patient outcomes. Despite advancements in antiplatelet medications and drug-eluting stent (DES) technology, ST remains associated with considerable morbidity and mortality. Notably, ST is an adverse event arising from various factors, including patient characteristics, stent-related issues, and procedural complications. In such a context, intravascular imaging (IVI) plays a pivotal role in assessing the underlying mechanisms and guiding treatment decisions. The use of thrombus aspiration and intracoronary antithrombotic therapies have been debated in the context of de novo acute myocardial infarction, but they could have a remarkable role for ST. However, the optimal management of ST requires individualized approaches tailored to patient-specific factors. This review provides a comprehensive analysis of the current understanding of ST, encompassing its incidence, outcomes, and risk factors, focusing on procedural acute management.

CHA2DS2-VASc score predicts periprocedural complications and mortality of percutaneous coronary intervention irrespective of atrial fibrillation: a systematic review and meta-analysis

Abstract Funding Acknowledgements None. Background Periprocedural complications of Percutaneous Coronary Intervention (PCI) are dreaded as they negatively impact prognosis, but they are hard to predict especially in resource-limited settings. CHA2DS2-VASc Score, apart from predicting thromboembolic risk in atrial fibrillation, has been reported to be associated with several complications of PCI. Purpose We aimed to assess the predictive value of CHA2DS2-VASc score for periprocedural complications and mortality in Acute Coronary Syndrome (ACS) patients treated with PCI. Methods Systematic search of the literature was conducted through Pubmed and Embase for all articles published from inception until 24th September 2023. Studies were included if they were observational studies conducted in ACS patients who received PCI during index hospital stay and evaluated the value of CHA2DS2-VASc score to predict at least one outcome of interest. Studies were excluded if they only used modified CHA2DS2-VASc score or did not conduct a separate analysis for ACS patients. Results Out of 1,783 manually reviewed unique studies, 34 studies involving a total of 342,141 ACS patients were included. Only 2 studies exclusively included patients with atrial fibrillation. Random effect meta-analyses found a significant association between high CHA2DS2-VASc score and Contrast-Induced Nephropathy/CIN (11 studies; OR 5.35; 95%CI 3.56–8.03; I2=94%), no-reflow phenomenon (14 studies; OR 3.21; 95%CI 2.20–4.68; I2 = 91%), acute stent thrombosis (3 studies; OR 5.23; 95%CI 3.85–7.10; I2=0%), in-hospital all-cause mortality (9 studies; OR 3.25; 95%CI 1.65–6.44; I2=91%), in-hospital cardiovascular mortality (3 studies; 3.05; 95%CI 1.58–5.87; I2=38%), post-discharge all-cause mortality (4 studies; 3.35; 95%CI 2.24–5.02; I2=0%), and post-discharge cardiovascular mortality (3 studies; 3.65; 95%CI 2.65–5.01; I2=35%). The CHA2DS2-VASc score cut-off with the highest OR for each outcome was used in bivariate random-effects meta-analysis model for diagnostic test accuracy. CHA2DS2-VASc score cut-off of ≥4 is a good predictor of CIN/AKI (5 studies) with AUC 0.81 (0.77–0.84), sensitivity 0.70 (0.51–0.84), specificity of 0.81 (0.54–0.94), while CHA2DS2-VASc score cut-off of ≥2 is good for screening no-reflow phenomenon (5 studies) with AUC 0.70 (0.66–0.74), sensitivity 0.86 (0.56–0.97), specificity 0.44 (0.20–0.71), and for screening in-hospital all-cause mortality (5 studies) with AUC 0.77 (0.73–0.81), sensitivity 0.88 (0.77–0.94), and specificity 0.35 (0.19–0.55). Conclusion CHA2DS2-VASc score is a rapid, non-invasive, and easily measurable tool that provides a good prediction of CIN/AKI, as well as a useful screening tool for no-reflow phenomenon and in-hospital all-cause mortality in ACS patients who received PCI regardless of their atrial fibrillation diagnosis.CHA2DS2-VASc score cut-off 4 for CIN/AKICHA2DS2-VASc cut-off 2 for no-reflow

Outpatient PCI - early discharge PCI, single center experience

Abstract Funding Acknowledgements None. Background Percutaneous coronary intervention (PCI) has undergone rapid evolution over the last years and is currently a widely generalized therapeutic option. In the past, it was associated with a significant rate of complications, yet, with the improvement of new generation drug eluting stents, and the radial access (RA) development, PCI has become safer and simpler, with a minimum rate of complications. This allows patient’s faster discharge. Besides the pressure from the limited number of beds in wards, the improvement of PCI has given the confidence to urge outpatient PCI programs. However, there are still centers where there is no ambulatory PCI. Purpose This study aims to describe our center experience of ambulatory PCI program, in terms of safety and efficacy. Methods We analyzed our center’s retrospective cohort of 723 PCI, in 2022. Ambulatory PCI was defined as PCI with same day hospital discharge. Our inclusion criteria were patients submitted to PCI. We excluded patients with acute coronary syndromes and patients needing hospital admission for other non-coronary reasons. Results 467 (65%), of the 723 PCI were performed in ambulatory setting. Patients mean age was 67,8±11 years and 23% (n=107) were female. In 12% (n=55) of the cases, the coronary anatomy was previously known, from a differed procedure. 63% (n=298) had a normal left ventricle ejection fraction (LVEF), 6% (n=26) had a moderate depression of LVEF and 3% (n=13) had LVEF severe depression. RA was possible in 82% of the cases (n=384), and 18% (n=83) of PCI was done by femoral access (FA). The access size was 6 Fr in 77% (n=359) of the cases, 7Fr in 22% (n=105) and 8Fr in 1% (n=2). The RA hemostasis was by compression (either manually or by external device) and FA hemostasis was first intended by closing device, however in 17% of the transfemoral PCI (n=14) had to be compressed, due to device hemostasis failure. PCI was successful in 97% of the cases (n=449), with revascularization of the goal lesion. The unsuccessful PCI (3% n=18) were because uncrossable lesion in 2% (n=14), and no reflow after PCI in 1% (n=4). 6 patients had to be admitted, after planned outpatient PCI, 5 due to peripheral access complication with hemorrhage of FA (after closing device and manual compression failure) and 1 due to PCI complication, with small coronary perforation. There was a higher probability of admission in patients submitted to transfemoral PCI (p&amp;lt;0,05), and there was no statistically significant relation between unplanned admission and patient’s LVEF. There were no episodes of death, MACE, non-planned hospital readmission and stent failure in the ambulatory PCI population. PCI has become a predictable and reliable technique, capable to treat outpatients. Patients undergoing successful non-complex PCI, without events, can safely be discharged on the same day. Outpatient PCI helps with the functioning of inpatient care, allowing beds to be freed up for other situations.